engIran University of Medical SciencesInternational Journal of Hospital Research2251-89402322-20852015-03-0141189041A Nurse Scheduling Model under Real Life ConstraintsSedigheh Azimisedigheh_azimi@qwert.com1Mohammad Mehdi Sepehrimehdi.sepehri@gmail.com2Masoud Etemadianmasoud.etemadian@gmail.com3Department of Industrial Engineering, Tarbiat Modares University,Tehran IranDepartment of Industrial Engineering, Tarbiat Modares University,Tehran IranHospital Management Research Center(HMRC), Iran University of Medical Sciences, Tehran, IranBackground and Objectives: In this paper, a real life nurse scheduling model is described based on the conditions in Iranian hospitals such as monthly shift rotation, consecutive morning and evening shifts and consecutive evening and night shift. Methods: The developed model considers both hospital constraints and nurses’ preferences. Hospital constraints include assigning adequate qualified number of nurses to all working shifts and avoiding inappropriate sequence of nursing shifts. Nurses’ preferences include the nurses’ monthly requests and observing the fairness in ratio of work hours, off weekends, night shifts and undesirable shifts. A hybrid of lexicograph and weighted sum method was used to solve the multi objective problem. The objectives were normalized and the importance of the objectives was determined by the Analytical Hierarchy Process method. In this work, new conditions are considered based on customized considerations. The model was evaluated by comparing the computationally determined schedules with manually determined schedules. Findings: Comparison of the manually and computationally determined schedules shows the superiority of computer-based method over the traditionally manual method based on the scales of the hospital. Conclusions: The study provides further support for the utility of sophisticated computational method in improving hospital processes, which can ultimately translate into enhanced patient care and hospital performance.http://ijhr.iums.ac.ir/article_9041_4fcccb5923ff1441c019bc5dfb7a9243.pdfNurse schedulingNurse preferenceShift rotationHospital ئanagementengIran University of Medical SciencesInternational Journal of Hospital Research2251-89402322-20852015-03-01419149042Development of an Assessment Model for Evaluating the Performance of Nursing ServicesTuğba MERTtugba_mertt@hotmail.com1Dilek EKİCİdocdrdilekeekici@gmail.com2TOBB ETU Hospital, Ankara, TurkeyNursing Department, Health Sciences Faculty, Gazi University, Besevler/Ankara, TurkeyA Model for Evaluating the Performance of Nursing Serviceshttp://ijhr.iums.ac.ir/article_9042_f73141dec811d04f69991bb101d09cde.pdfNursing performanceHealth careVisit FormengIran University of Medical SciencesInternational Journal of Hospital Research2251-89402322-20852015-03-014115209130Cultural Competence: A Survey of Hospital ManagersAhmadreza Raeisi1Mohanna Rajabi2Mahmoud Keyvanara3Department of Health Services Management, Isfahan University of Medical Sciences, Isfahan, IranDepartment of Health Services Management, Isfahan University of Medical Sciences, Isfahan, IranDepartment of Health Services Management, Isfahan University of Medical Sciences, Isfahan, IranBackground and Objectives: Effective communication between managers and staff is a prerequisite to organization success. Cultural competence is key to effective communication. The aim of this study was to survey cultural competence in managers of selected hospitals. Methods: Twenty teaching hospital managers and four private hospital managers of senior level participated in the study. Data were collected via research-made questionnaire which was examined in terms of validity and reliability. The questionnaire consisted of 30 questions related to three dimensions of cultural competence, including cultural awareness, cultural knowledge, and cultural skills. Data were summarized using descriptive statistical methods. T-test was used for comparison of the mean values. Findings: The average score of cultural awareness, cultural knowledge and cultural skills was found to be 42.41, 45, 44.12, respectively giving a total cultural competence score of 43.84. No significant difference in cultural competence and its dimensions was observed between managers of teaching and private hospitals. Conclusions: According to our study, the surveyed hospital managers enjoy a relatively high cultural competence, though there is still room for further improvement particularly in terms of cultural skills. The relatively small sample of this study, however, warrants caution in generalization of the results and call for further large-scale studies to explore this important factor among hospital managers.http://ijhr.iums.ac.ir/article_9130_3d4b1b11c7b98f3afb97a3e413b0d841.pdfCultural competenceHospital managerCommunicationHospital PerformanceengIran University of Medical SciencesInternational Journal of Hospital Research2251-89402322-20852015-03-014121269131Active Leadership Can Promote Leadership Effectiveness in Healthcare OrganizationsAli Sarabisarabi.a@iums.ac.ir1Iran University of Medical ScienesBackground and Objectives: The healthcare organization are often fail to realize their strategic goals due to the lack of effective leadership. To address this efficiency, factors can possibly influence the management performance should be identified. Thus, the purpose of this study was to evaluate hospital managers’ leadership style and explore the relationship between leadership style in hospital executive managers and their leadership readiness and leadership effectiveness. Methods: The study sample included the entire (96) C-level healthcare executives currently employed in the Iran University of Medical Sciences, including chief executive officer (CEO), chief financial officer (CFO), chief human resource officer (CHRO), chief information officer (CIO), chief nursing officer (CNO), and chief operating officer (COO). The study instrument was a questionnaire asking about respondents’ leadership style questions, leadership effectiveness and leadership readiness. The collected data were analyzed using Pearson’s correlation coefficient and single variable and multivariate regression. Findings: Transformational leadership was found to be the dominant leadership style among the executive managers. The leadership readiness was found to be significantly correlated with transformational leadership (P < 0.05). Moreover, leadership effectiveness showed significant correlation with transformational/transactional leadership style (P < 0.05). Conclusions: Our study suggests that adopting active management which represents both transformational and transactional managing style can lead to an improved leadership effectiveness in healthcare organizations.http://ijhr.iums.ac.ir/article_9131_e9b90707be865acdb71798509d6246aa.pdfHospital managementHealthcare organizationLeadership styleLeadership effectivenessLeadership reedinessTransformational LeadershipTransactional leadershipengIran University of Medical SciencesInternational Journal of Hospital Research2251-89402322-20852015-03-014127329133Clinical Audit of Emergency Department Triage: The Impact of Interventional StrategiesJafar Sadegh Tabrizi1Mahboub Pour-Aghayipouraghaeim@yahoo.com2Leila Abdollahiabdollahiabed_leila@yahoo.com3Amin Daemidaemi.a@tak.iums.ac.ir4Soheila Sherkati5Rouhollah Yaghoubiyaghoobi_ru@yahoo.com6Health Services Management Research Center, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, IranDepartment of Emergency Medicine, School of Medicine, Tabriz University of Medical Sciences, Tabriz, IranStudents Research Committee, Tabriz University of Medical Sciences, Tabriz, IranHealth Management and Economics Research Center, Iran University of Medical Sciences, Tehran, IranEmergency Department, Shahid Madani Specialty Hospital of Heart, Tabriz, IranDepartment of Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, IranBackground and objectives: The Iranian Ministry of Health and Medical Education (MOHME) has obligated health settings to follow the reference guidelines developed by the Ministry in implementing of emergency department triage system. The present study aimed at auditing the compliance of emergency department triage system in Shahid Madani hospital, in terms of compliance with MOHME guideline, and to explore the impact of relevant interventions in enhancing this compliance. Methods: A check list developed based on the Ministry’s guideline was used as the study instrument. Two areas including inputs and processes were surveyed. After auditing the initial state of the triage system, interventional strategies such as keeping the triage active in the afternoon and night shifts, allocation of welcoming patient carrier, and training the staff on the standards of triage system was implemented and the triage system was re-audited. Descriptive statistics and graphs were used to describe the results. T-test was used to compare the degree of compliance before and after intervention. Findings: Before introducing the intervention, a compliance degree of 80, 62, and 88%, the standards of physical space, staffing, facilities and equipment and 80%, 14% and 67% to service process, logistic process, and management process was identified, respectively. After implementation of intervention, the degree of compliance was found to be 80, 87, 92% for the three former areas, and 90%, 14% and 100% for the three latter areas, respectively. The overall degree of compliance showed a significant increase from 75% to 82% after intervention (P = 0.028). Conclusions: The adherence of emergency department triage system to the reference standards can be improved by implementing relevant interventional strategies. The gap between degree of compliance after intervention and the ideal situation, however, shows the need for more comprehensive identification of the shortcoming and devising appropriate strategies.http://ijhr.iums.ac.ir/article_9133_ab69ab74ad0b1e4d79c6e22d8b72da95.pdfClinical auditTriageEmergency departmentHospital managementengIran University of Medical SciencesInternational Journal of Hospital Research2251-89402322-20852015-03-014133369134Comparison of Six-Month Patency Rate in Ulnar-Basilic Fistula and Radio-Cephalic Fistula for Hemodialysis AccessAlireza Khazaeiiran khazaei@zaums.ac.ir1Mehdi Ramezanimehdiramezani1391@gmail.com2Rooholla Bakhshidr.bakhshi2013@gmail.com3Mehdi Mohammadime mohamadi@yahoo.com4Abdolvahhab Pourmahmudian5Zahedan University of Medical SciencesZahedan University of Medical SciencesZahedan University of Medical SciencesZahedan University of Medical SciencesZahedan University of Medical SciencesBackground and Objectives: There are different types of vascular access. We compared the patency rate for six months in ulnar-basilic fistula and Radio-Cephalic fistula for vascular access in hemodialysis patients. Methods: The study was performed on 60 patients of 50.6±13.5 years of age with end-stage renal failure undergoing hemodialysis from 2012-2014 in Imam Ali hospital in Zahedan. Patients were divided into two groups. The first group was established anastomosis of wrist radial artery and the cephalic vein and in second group between ulnar artery and vein Basilic in the forearm. Both groups were followed up with respect to patency of the fistula for six-month. Findings: The mean duration of renal failure requiring transplantation among patients was 1.4±1.0 year. The frequency of patency after six months in ulnar-basilic fistulas was less than that in Radio-Cephalic group, however, the difference was not significant (76% vs. 70%, P > 0.05). All fistulas in two groups showed thrill, except one patient (3.3%) in ulnar-basilic group (primary failure). Hypertension was detected in one patient in Radio-Cephalic group, moreover, hematoma was observed in two patients in ulnar-basilic and in two patients in Radio-Cephalic groups and thrombosis was observed in two patients in ulnar-basilic and in a single patient in Radio-Cephalic groups. The aneurism was observed in three patients (10%) in ulnar-basilic and in four patients in Radio-Cephalic fistulas. The steal syndrome was observed in two patients in Radio-Cephalic group, infection in one patient (3.3%) in ulnar-basilic fistulas group and in four patients (13.3%) in Radio-Cephalic group. Conclusions: Fistula patency rates were comparable in both ulnar-basilic and Radio-Cephalic groups and there is no significant evidence of postoperative complication difference between two groups.http://ijhr.iums.ac.ir/article_9134_6e5596a050ffcdd83c77812e964e079e.pdfHemodialysisulnar-basilic fistulaRadio-Cephalic fistulaESRDengIran University of Medical SciencesInternational Journal of Hospital Research2251-89402322-20852015-03-014137429135Challenges and Potential Drivers of Accreditation in the Iranian HospitalsMohammad Saadatihcm.2020@gmail.com1Khadijeh Yarifardyarifard.e5426@yahoo.com2Saber Azami-Agdash3Jafar Sadegh Tabrizijs.tabrizi@gmaol.com4Student Research Committee, Iranian Center of Excellence in Health Management, Department of Health Service Management, School of Health Services Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, IranStudent Research Committee, Iranian Center of Excellence in Health Management, Department of Health Service Management, School of Health Services Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, IranHealth Management and Economics Research Center, Iran University of Medical Sciences, Tehran, IranTabriz Health Service Management Research Centre, Department of Health Service Management, School of Health Service Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, IranBackground and objectives: Accreditation is a widely used mechanism to keep organization adherent to the established standards. The aim of the study was to identify barriers towards promotion of accreditation in the Iranian hospitals, and exploring the potential overcoming strategies. Methods: A qualitative study design was adopted. Data were collected using a questionnaire with open questions about barriers to and potential solutions of accreditation implementation in Iranian hospitals (N= 116). Thematic analysis was used to extract the major concepts. Findings: Limited knowledge of the personnel, inadequate training of the staff and lack of commitment of managers and physicians were identified as the most important challenges towards successful implementation of accreditation. Respondents enumerated extensive training, involvement of chief managers, and adapting the hospital’s organizational culture as the potential drivers of accreditation in the Iranian hospitals. Conclusions: The three categories of barriers to accreditation as well as the suggested overcoming strategies are interconnected, all of which pointing towards the need for extensive training for developing the required infrastructure, at least in terms of human resources, for promotion of accreditation in the Iranian hospitals.http://ijhr.iums.ac.ir/article_9135_b55786e873658e02d7dc3c4f5520f39a.pdfaccreditationHospitaltrainingHospital managementOrganizational CultureengIran University of Medical SciencesInternational Journal of Hospital Research2251-89402322-20852015-03-014143469046The Effect of Training in Promotion of Hand Hygiene in HospitalAli Majidpour1Sayyed Gholamreza Fanaei2Mohamad Hussein Behzad Moghadam3Ehteram Ahmadi4Najmeh Gazvini5Marjan Daneshvar Tehrani6Abolfazl Adhami7Somayeh Soleymanzadeh Moghadam8Antimicrobial Resistance Research Center, Iran University of Medical Sciences, Tehran, IranInfection Control Committee of Erfan Hospital, Tehran, IranInfection Control Committee of Erfan Hospital, Tehran, IranInfection Control Committee of Erfan Hospital, Tehran, IranInfection Control Committee of Erfan Hospital, Tehran, IranInfection Control Committee of Erfan Hospital, Tehran, IranInfection Control Committee of Erfan Hospital, Tehran, IranAntimicrobial Resistance Research Center, Iran University of Medical Sciences, Tehran, IranBackground and Objectives: Hand hygiene (HH) is crucial for preventing of infectious complications in health care settings. Informing healthcare workers on the recommended hand washing method can promote this practice in the clinical staff. This study aimed to evaluate the impact of training the WHO-recommended five-moment hand washing method in promoting hand hygiene in a health care setting. Methods: Ninety-eight clinical staff of Erfan Hospital participated in a training course. After training, the frequency of hand washing by the participants was compared with that before training. Chi-square test was used for examining the significance of the difference. Findings: A significantly increased frequency of hand-washing was observed in the clinical staff after the training course (P < 0.05). Conclusions: This study emphasizes the importance and effectiveness of training in controlling factors contributing to provenance of nosocomial infections.http://ijhr.iums.ac.ir/article_9046_f391bc3594d7b4ae4c1f555f83581566.pdfHand hygieneHand washingNosocomial infections